Automated control of oxygen titration in preterm infants on non-invasive respiratory support.

Objective: To evaluate the performance of a rapidly responsive adaptive algorithm (VDL1.1) for automated oxygen control in preterm infants with respiratory insufficiency.

Design: Interventional cross-over study of a 24-hour period of automated oxygen control compared with aggregated data from two flanking periods of manual control (12 hours each).

Setting: Neonatal intensive care unit.

Participants: Preterm infants receiving non-invasive respiratory support and supplemental oxygen; median birth gestation 27 weeks (IQR 26-28) and postnatal age 17 (12-23) days.

Intervention: Automated oxygen titration with the VDL1.1 algorithm, with the incoming SpO signal derived from a standard oximetry probe, and the computed inspired oxygen concentration (FiO) adjustments actuated by a motorised blender. The desired SpO range was 90%-94%, with bedside clinicians able to make corrective manual FiO adjustments at all times.

Main Outcome Measures: Target range (TR) time (SpO 90%-94% or 90%-100% if in air), periods of SpO deviation, number of manual FiO adjustments and oxygen requirement were compared between automated and manual control periods.

Results: In 60 cross-over studies in 35 infants, automated oxygen titration resulted in greater TR time (manual 58 (51-64)% vs automated 81 (72-85)%, p<0.001), less time at both extremes of oxygenation and considerably fewer prolonged hypoxaemic and hyperoxaemic episodes. The algorithm functioned effectively in every infant. Manual FiO adjustments were infrequent during automated control (0.11 adjustments/hour), and oxygen requirements were similar (manual 28 (25-32)% and automated 26 (24-32)%, p=0.13).

Conclusion: The VDL1.1 algorithm was safe and effective in SpO targeting in preterm infants on non-invasive respiratory support.

Trial Registration Number: ACTRN12616000300471.